HOW HL7 GERMANY GOES FHIR AND BEYOND...

HL7Germany

ESPERIENZE INTERNAZIONALI:

HOW HL7GERMANYGOESFHIRAND BEYOND...

I° HL7 Italia FHIR Workshop : potenzialitàe prospettive comuni, Florence4 dicembre 2015

Dr. med. Kai U. HeitmannHeitmann Consulting and Services (DE)CEO HL7 Germany

Agenda

§ FHIRStructuresinGermany▶ TechnicalCommittee:aStrategyandaTaskList▶ HL7:ThreeGenerationofStandards!▶ Tooling– now and inthe Future

§ FHIR’sdiaboliccomponents▶ CriticalFactorsandCriticism

§ Conclusion

First FHIR Workshop HL7 Italy, Florence, 4 December 2015 2

TechnicalCommittees

First FHIR Workshop HL7 Italy, Florence, 4 December 2015 3

§ BoardofDirectorsdrivesandsupervisestheTechnicalCommittees

HL7 Germany Board of Directors

CDA and XML / V3

Messaging andVersion 2 Terminologies

Tools, Conformance

and TestingFHIR

CEO

FHIRTechnicalCommittee

§ InformationandEducation§ CommunityFormation§ MeetingsandWorkGroups§ CreateandmaintainProfilesandValueSets

▶ Connect-a-thons▶ Infrastructure▶ ToolsandBestPractice

§ BringFHIRintoPolitics,ScienceandIndustry§ InternationalRepresentation/Reports

First FHIR Workshop HL7 Italy, Florence, 4 December 2015 4

Informationand Education

§ WebsiteTopTopics§ Tutorialsatour AnnualMeetings

§ Hack-a-thons§ Videos(hl7.tv)§ Presentationsatothermeetings

First FHIR Workshop HL7 Italy, Florence, 4 December 2015 5

Informationand Education

§ Calmdownyourmembership▶ “Don‘tkicktheotherstandardsoutofthedoor”▶ …warn,encourage… andshowBestPractices

§ ExpectationManagement§ MigrationStrategies§ PilotProjects§ Blessingandcurse:NewandyounggenerationofAppbuilders– withnomedicalbackgroundatall

First FHIR Workshop HL7 Italy, Florence, 4 December 2015 6

HL7-Standards-Family

§ Version2.x▶ Messages(1987..)▶ v2.xml(2003..)

§ Version3▶ Messages(1995..)and Services▶ Documents =ClinicalDocumentArchitecture CDA(1999..)

§ FHIR (FastHealthcare Inter-operability Resources,2012..)

First FHIR Workshop HL7 Italy, Florence, 4 December 2015

FHIR

CDA

HL7v2

7

InteroperabilityParadigms

§ REST▶ Coreof FHIR,with GETandPOSTetc.

§ Documents▶ LikeCDA,Bundlesof Resources

§ Messages▶ Likev2undV3,Bundlesof Resources

§ Services▶ ServiceOriented Architecture

§ Alsoimportant – Formats:XMLvs JSONFirst FHIR Workshop HL7 Italy, Florence, 4 December 2015 8

Convergenceof Problems/Solutions

§ Segments§ Datatypes

HL7v2

§ Profile§ Z-Segments

§ Machine only

§ Ad-hocCoverage

§ Model(V3)§ Datatypes

HL7R1.1

§ Templates§ InformalExtensions

§ Human/Machine

§ 100%Coverage

First FHIR Workshop HL7 Italy, Florence, 4 December 2015

§ Resources§ Datatypes

PartiallyHL7R2/ISO21090

§ Profile§ FeaturedExtensions

§ Human/Machine

§ 80%Coverage

FHIRCDAHL7v2

9

ConvergenceofProblems/Solutions

Patient Summary

Patient

Author

Custodian

Family History

Current Medication

Medication

Problems

Problem

§ Templates/Profile

First FHIR Workshop HL7 Italy, Florence, 4 December 2015 10

A life withoutmapping is possible

but useless

Whathappenswhen?

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CDA

1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016

FirstMeetingHospital

UniversityofPA..

v2.0published

v2.1published

ChartermemberofANSIHISPP

Version3.0NormativeEdition2005

v1.0published

ImplementationSupportGuidepublished

v2.2published

v2.2ANSI

v2.3PublishedandANSI

Version 2.3.1PublishedandANSI

ArdenSyntax2.0 2.4

CCOW

MoreThanMessages

CDARelease1

1993:HL7Germany

v2.5published

v2.6published

CDARelease2

FHIR

CDA

FHIRDSTU2

FHIR1st draft

FHIRDSTU1

CommunityFormation

§ BLOG,CommunityMailingList,Twitter,Facebook,“smotare conbierra”

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FHIRProfiles+ValueSets

§ Creation▶ GermanProfiles▶ GermanDatatypes▶ GermanExtensions▶ GermanValueSets

§ Maintenance▶ Registryforprofiles,extensionsandvaluesets▶ Multi-PurposeTooling(TerminologyServers,Forge,ART-DECOR)

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§ ...is anopen-source tool andamethodology forvarious stakeholders ofhealthcare information exchange

ART-DECORin4bullets (1)

© auremar - Fotolia.com

© WANG HSIU-HUA - Fotolia.com

ART-DECORin4bullets (2)

§ ...supportscomprehensivecollaborationofteammemberswithinandbetweengovernancegroups

§ ...allowsseparationofconcernsanddifferentviewsononesingledocumentationfordifferentdomainexperts

§ ...supportscreationandmaintenanceofHL7templates(DSTU),valuesets,datasetsandmore

§ Oneofthemainobjectives▶ Separationofconcernstowardsacomprehensivespecification

▶ Differentviewsononesingledocumentation  Withchangingfocusondifferentartifacts  Fordifferentdomainexperts

ART-DECORmainobjective

OverviewART-DECOR®

ART-DECOR®

§ Used inGermanyfor▶ Creation andMaintenanceof CDA-relatedDefinitions  Templates  ValueSets

▶ Datasets(e.g.functional view onadiagnosis,anallergy,aprocedure)

▶ Terminology Referenceand Service▶ ApplicationPrototypeBuilding▶ BuildingBlockRepository(BBR)

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ART-DECORtemplates

ART-DECOR®andFHIRSupport

§ TerminologyServices§ ProfilesandExtensionRegistry

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ART-DECOR®Projects(some)

§ Internationalprojects(mainlyinEurope)▶ Austria (ELGANationaleHealth programme)▶ Netherlands(nationalscreeningprogramme onbowelcancer)

▶ Netherlands(Nictiz,multipleprojects)▶ Norway(HL7,regionalHealthnetworks)▶ epSOS/EXPAND(EuropeaneHealth programme)▶ Germany(HL7,nationaleHealth programme)▶ HL7PolandiEHR withCDA▶ EuropeanTemplatesandValueSetRepository(nascent)

▶ IHEProfileandValueSetRepository(indevelopment)

§ art-decor.org▶ Documentation▶ Internationalsite andinternationalprojects host

▶ blog.art-decor.org etc.

▶ Sourceforge§ decor.nictiz.nl

▶ Dutch projects host▶ Documentation,specification

ART-DECOR@ internet

FHIRPersons (DE)

§ SimoneHeckmannFHIRTCLead

§ CEO,BoD and other TCLeads

§ WorkingGroups

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Politics,Science,Industry

§ BringFHIRintoPolitics,ScienceandIndustry§ eHealth Law

▶ ContactwithPoliticians▶ Position/OpinionPapers▶ Hearings▶ “Bundestag”

§ Easier:Science,Industry– becausewearebetterinreachingourmembers

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Foto © Bundesregierung / Henning Schacht

Politics,Science,Industry

§ HL7Newsletter▶ DE,CH,AT,LU

§ PressReleasesHL7Germany

§ OpinionPaperswithotherorganizationse.g.IHE,VendorAssociationsetc.

Anwendertreffen Health-Comm 28. und 29. Oktober 2015 Nürnberg

InternationalRepresentation

§ FHIRConnect-a-thons§ FHIRDeveloperDays§ Reportstomembership§ WorkwithFHIRandtoolstomakeitabetterstandard

§ Re-thinkandre-fineconcepts§ Identifythreats

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HL7Germany

FHIR‘S DIABOLICCOMPONENTSWe arenotyet there...

Foto © Fotolia.de: miroslavmisiura

CriticalFactors andCritisism

§ InsteadofadoringtheModelersnowadoringtheImplementers

§ 80/20Rule§ Governance,Governance,Governance§ Health-ITisnotcomplexbecauseoftheITbutbecauseofHealth

§ Problemsremainthesame▶ Whatisanallergy?

§ ManyProblemstoseenyet,yettocomeFirst FHIR Workshop HL7 Italy, Florence, 4 December 2015 28

Toolingand Supportgrowing

§ Beyondtechnicalandsemanticalconnectivity

§ Usersatfrontends

§ Documentview

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TimeTableforTests

§ Sept2015:DSTU2published§ Jan2016:DSTU2.1ballot§ Spring2016:DSTU2.1published§ 2017:FirstNormativespecification§ Additionalreleasesevery12-18months

First FHIR Workshop HL7 Italy, Florence, 4 December 2015 Foto © Fotolia.de: fotomek30

HL7Germany

CONCLUSION

Conclusions:Strategyand Tasks

§ InformationandEducation§ CommunityFormation,MeetingsandWorkGroups

§ CreateandmaintainProfilesandValueSets▶ Connect-a-thons,Infrastructure▶ ToolingandBestPractice

§ BringFHIRintoPolitics,ScienceandIndustry§ InternationalRepresentation/Reports§ VivaItalia!…butdon’tforgetEurope

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HL7Germany

GRAZIE!THANK YOU!Questions?

Dr.med.KaiU.Heitmann,MD,FHL7HeitmannConsultingandServices,Germany

CEOHL7GermanyART-DECORExpertGroup

TemplatesCo-chairHL7Internationalinfo@kheitmann.de